Provider Demographics
NPI:1427115294
Name:DWYER, ANN-MARIE XAVIER (MSW, LISW-CP)
Entity type:Individual
Prefix:MS
First Name:ANN-MARIE
Middle Name:XAVIER
Last Name:DWYER
Suffix:
Gender:F
Credentials:MSW, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 HARDEN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-3143
Mailing Address - Country:US
Mailing Address - Phone:803-898-2249
Mailing Address - Fax:803-898-8590
Practice Address - Street 1:101 HARDEN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-3143
Practice Address - Country:US
Practice Address - Phone:803-898-2249
Practice Address - Fax:803-898-8590
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC47981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC32750Medicare UPIN